Dysmenorrhea: A Clinical Note *

It has been estimated that about thirty-five per cent of all women in the child-bearing age suffer from dysmenorrhea in some form. This single fact is sufficient to justify an earnest effort to improve our understanding of its causes and treatment. Too often the condition has been regarded solely as a symptom, deserving only of symptomatic treatment, without a consistent effort to discover underlying causes and means of correcting them. This communication aims (1) to summarize briefly our present knowledge of the syndrome, and (2) to describe a therapeutic procedure which, by treating a presumable cause, is producing gratifying effects. Essential or primary dysmenorrhea usually dates from the beginning of the menstrual career and is characterized by complete free dom from signs and symptoms in the interval between the periods. The usual assertion that it is attended with no gross local pathology is misleading, and should be strictly qualified. Many cases present no demonstrable organic background, but displacements of the uterus or stenoses of the cervix are quite as often congenital as acquired, and may be responsible for a true primary type. Acquired or secondary dysmenorrhea is a condition usually associated with demonstrable pelvic pathology, or dependent upon intercurrent constitutional disorders. It most frequently accompanies: ( 1 ) an inflammatory lesion such as salpingitis, adherent ovaries with thickened capsules, or chronically engorged pelvic veins; (2) a neoplasm such as fibromyoma or more particularly an adenomyoma, or, most commonly, endometriosis; or (3) an acquired uterine displacement or cervical stenosis subsequent to trauma. Therefore, the dysmenorrheas should be classified on the basis of their chronology or occurrence-time, rather than upon their pathological background, since identical organic factors may operate in both types. Study, observation, and treatment of the problem can